Published 12/04, Copyright 2004,

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In today's mobility market, pressure management is of greater visibility than ever before.  While most users have long had a heightened awareness of pressure sores, the global news stories relating pressure sore complications to Christopher Reeve's death brought the issue to near universal conversation.  However, as the news stories fade, the issue remains a foremost battle in many wheelchair users' daily lives.

For those most at risk of pressure sores, there's only one safest bet - that is, relieving as much pressure as possible throughout the day.  While getting out of one's chair as much as possible, relieving pressure points, is an ideal, it's impractical toward living an active lifestyle.  The alternative, then, is to relieve pressure points when seated in the chair throughout the day, commonly via a tilt seating system.  But is tilting the most appropriate means of pressure relief for all, and what effects does reclining bring to the pressure management equation?  

The premise of tilt systems is that by tilting the entire seating system up to 55-degreees rearward, weight is redistributed from the buttocks and thigh region, to the posterior upper body.  For users with extensor tone consequences - often related to cerebral palsy, spinal cord injuries, and head injuries - tilt systems are especially vital in that they redistribute pressure without disturbing the user's positioning, maintaining ankle, leg, and hip angles.  Of utmost importance, many users can independently operate a tilt system, allowing weight shifts as often as needed.

Tilt systems can, however, have drawbacks for some users.  Maintaining a fixed hip angle, as with near 90-degrees due to a constant seat-to-back position on a tilt system, can cause bladder constriction.  What's more, environmentally, tilt systems may prove awkward for some users, not allowing use when working at a desk, eating at a table, or traveling in some vans.  Further, because most tilt systems dramatically elevate the knees and feet, some users feel noticeably out of place when tilting in more formal environments.

While in recent years tilt systems have been more prescribed for pressure management than recline systems, reclining remains an integral tool in pressure management for many.  Whereas a tilt system tilts the entire seat, a recline system maintains a fixed seat angle, and opens the seat-to-back angle, reclining the user's upper body rearward.  Additionally, many recline systems have elevating legrests to facilitate motion at the knees in conjunction with the hips as the user reclines.  Reclining to 168-degrees, in conjunction with the use of elevating legrests, can dramatically decrease pressure in the buttocks and thigh region.  Beyond reducing pressure, recline systems may also foster improved bladder and bowel health by opening up the hip region, as well as ease such personal care as catheterization.  Further, some users feel that reclining is less obtrusive means of pressure relief when working at a desk, traveling in a van, or attending public events.  

Despite the many benefits of recline systems, they're not appropriate for all users, namely those who cannot tolerate a change in position, as with those with limited range of motion, or those susceptible to spastically when seat-to-back angles open. Also, although low-sheer backs - a backrest that follows the user as the system reclines, reducing friction on the user - are commonplace on many power recline systems, some friction still occurs, and such reclining movement can also disturb overall positioning.  For these reasons, recline, as pressure management, isn't suited for all.

For some users, tilt and recline combined are an ideal, allowing the fullest range of pressure relief possibilities.  However, many insurers, including governmental, are reluctant to fund both systems on one chair, seeing fit to only fund one pressure management technology.  Some users and providers have navigated around single technology funding limits by individually justifying each technology, as with a tilt system for pressure relief, and a recline system to facilitate catheterization.  

Whether one uses a tilt, recline, or both, the health benefits gained can prove profound.  However, the key to maximizing the benefits of pressure management systems isn't only in understanding the technologies, but also in proper applications.  Applying the right technologies, with the right techniques, ensures the highest levels of health and comfort, maximizing one's active lifestyle.

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